Active NPI
Michael John Peneguy, DDS
- Dentist
- Thibodaux, LA
National Provider Identifier
1154338457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5203
- Practice address
- 824 Ridgefield Rd
Thibodaux, LA 70301-2726 - Phone
- (985) 446-8815
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5203 | LA | Primary |
Addresses
Primary practice location
824 Ridgefield Rd
Thibodaux, LA 70301-2726
Mailing address
PO Box 630
Thibodaux, LA 70302-0630
Phone (985) 446-8815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190218000605 | LA | Order and Referring Only - Dentist | 7113265182 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5203 | LA | MD | Audiologist-Hearing Aid Fitter |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154338457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 630",
"city": "THIBODAUX",
"state": "LA",
"postal_code": "703020630",
"telephone_number": "985-446-8815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "824 RIDGEFIELD RD",
"city": "THIBODAUX",
"state": "LA",
"postal_code": "703012726",
"telephone_number": "985-446-8815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENEGUY",
"first_name": "MICHAEL",
"middle_name": "JOHN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "5203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Thibodaux, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.